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13USINEss CERT1F]CATE ft 09 <br /> THE C0mn10A'1J1hALTI10F3IASVllCf1US1`T7S <br /> T06V1\'OI'MASK/PL'L <br /> • DATE <br /> Expiration Date: DeGeinbei- 31, 2013, <br /> In conformity with the provisions 01' Chapter one Imndred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declare(s) that a business under the title of <br /> j t DG3A pr�Q �', f VK- _ ,iis conducted at <br /> Business Location: / U�.i�77770.�t��-.t<S e- yt� <br /> � ,1 I" 'e-.r a4,ee "IJP U9b 1 1 <br /> Business Mailing Address: Lfk r\OLU t S 5`e+ imf e4 ST10) _ <br /> Business Type: fw -m C�0.1�(�, Business Telephone: ���- t{. 7 / <br /> by the following trained persons: <br /> FUL NAME RBSIDENC= <br /> s � rT e� `Cl Chu 1� ISSP WU ? <br /> Horne Phone: 1-7 7 " d�f E 3 - <br /> 1 certify under the penalties of perjury that 1, to the best of iry knowledge and belief, have filed all.state tax retruns and paid all state <br /> Aaas required under law. - <br /> C-red o <br /> tat, of authorized 19cilt *Signature of authori ed agent <br /> 7& - 0 7ggl `t s <br /> .*Social Security Number(Voluntary) <br /> or Federal Identification Number <br />'i pp -�}— LL case of emergency q - - 4- - - - <br /> NAME X�) i4 sX TELEPHONENUMBER771 <br /> Alarm Company: - - - <br /> *This license will not be issued unless this certification is signed by applicant <br /> *"YOUl Social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or"N"'catiop. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Conuvonmealth of D4ass'achusetts � <br /> 13ARNSTABLE ss DATE �/-f <br /> Personally appeared bcfere me the above-named P ro and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed <br /> Signed <br /> VVV <br /> Debora F. Dami <br /> • - NOTARY PUBLIC Notary Public <br /> SEAL, _ Commonwealth of Massachusetts <br /> My Commission Expires July 24,2009 <br /> Commission Expi res: <br />